Fulfilling The Quality Mandate for ALL – We Are NOT There Yet

QualityLast month, I attended the annual National Quality Forum Conference in Washington, DC. This year’s theme was: Fulfilling The Quality Mandate – Are We Closer To Safer, More Effective, and Affordable Care?

A major theme was that of racial disparities in care.

I decided to look into the question of racial disparities in wound care using US Wound Registry data. Below is a snapshot of USWR data on diabetic foot ulcers (DFUs). African-American (Black) patients represent 18.4% of the diabetic foot ulcers in the dataset. Their overall healing rate is significantly less than that of Whites, and their amputation rate is significantly higher. I honestly didn’t think the numbers would be this… impressively different. Would you have expected this? This is data largely from hospital-based outpatient wound centers. We are supposed to be where the buck stops when it comes to wound care.

We have the ability to stratify the USWR data by DFU severity and create matched cohorts to better examine the impact of race among equally severe DFUs. We could evaluate whether there was a racial difference in medication regimen for hypertension and diabetes, smoking propensity, timing of referral to the wound center, referral for revascularization, the use of advanced therapeutics and many other factors. I did take just a quick peek at the number of Cellular and/or Tissue based products used by race in DFUs and it doesn’t appear to be different. However, that’s just a quick look at DFUs as a whole, not by severity, number of applications, etc.

There are clearly reasons for the numbers below. We could figure it out, but that would take—yes—funding. I don’t apply for grants anymore because it’s all I can do to keep quality reporting going. The USWR isn’t a device registry so it doesn’t get industry funding — not that we’d refuse it! (We do have the e-Prescribing data on all these patients, but we don’t seem to garner interest from Pharma either.) As an aside, in our analysis of the predictive outcome of arterial ulcers, patients with arterial ulcers who were taking Plavix were more likely to have a good outcome. FYI:

Race DFUs Amputated % Healed %
White 25,219 3.2% 51.4%
Black 4,652 4.6% 46.7%

Are We Closer to Safer, More Effective Care?

Maybe. I can now prove that the doctors who participated in wound care quality reporting through the USWR had a statistically significant improvement in the honest healing rates for DFUs and VLUs. Maybe the doctors who participate in quality reporting are fundamentally different from those who don’t. I’ll be talking about this topic at the SAWC Spring in Charlotte. I hope you will join me there next month.

Thanks to quality reporting, we are a little closer to safer, more effective wound care. What we don’t seem to be closer to is overcoming racial disparities in the outcome of DFUs. I’d like to understand why.